. Diseases of the stomach : including dietetic and medicinal treatment . in the pyloricregion. In some cases it may completely surround the pyloric canal; inothers it may appear as a diffuse infiltration of the coats of the stomachin this region, with raised edges and depressed centre, resembling ahealed scar of a chronic ulcer; while in still other cases one may see atthe pylorus a localized, more or less globular tumor, with some cysticor colloid degeneration, and often extensive central ulceration. In allof these forms there is frequently quite marked stenosis of the pylorus,with subsequent
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. Diseases of the stomach : including dietetic and medicinal treatment . in the pyloricregion. In some cases it may completely surround the pyloric canal; inothers it may appear as a diffuse infiltration of the coats of the stomachin this region, with raised edges and depressed centre, resembling ahealed scar of a chronic ulcer; while in still other cases one may see atthe pylorus a localized, more or less globular tumor, with some cysticor colloid degeneration, and often extensive central ulceration. In allof these forms there is frequently quite marked stenosis of the pylorus, with subsequent dilatation of the stomach. The mucous membrane overthe growth is indurated and tough, immovable upon the underlyingtissues, may be uneven and show small nodules of tumor tissue. Veryoften there is superficial or deep ulceration. Fig. 35. Scirrhous carcinoma of pylorus. Pyloric half of stomach obtained at operation. D, duodenum;P, pyloric valve; L, lumen of the much contracted pyloric canal; M, muscularis showing the inva-sion by the carcinoma, C, C. The white, thickened strands of connective tissue are well seen, alsothe hypertrophy and diffuse carcinomatous infiltration of the muscularis and submucosa gradualljdecreasing in intensity toward the cardia. On section of the stomach wall through the tumor, all of the coatsare found thickened, especially the submucosa, whose slightly concave, hard surface appears smooth, white, and glistening. The muscularis, especially the circular coat, is considerably hypertrophied, and istraversed by glistening white strands of connective tissue. More uncommonly scirrhous carcinoma may occur as a diftuse in-filtration of the whole stomach wall. This leads to great increase inthickness of the gastric wall, generally most marked at the pylorus, and extreme reduction in the size of the organ